RESUMO
In this study, we aimed to evaluate the incidence and economic burden of prosthetic joint infections [PJIs] in a university hospital in a middle-income country. Surveillance data between April 2011 and April 2013 in the Orthopedic Surgery Department was evaluated. Patients [>16 years old] who had primary arthroplasty in Erciyes University were included in the study, and patients with preoperative infection were excluded. Patients were followed up during their stay in the hospital and during readmission to the hospital for PJI by a trained Infection Control Nurse. During the study period, 670 patients were followed up. There were 420 patients [62.7%] with total hip arthroplasty [THA], 241 [36.0%] with total knee arthroplasty [TKA] and 9 [1.3%] with shoulder arthroplasty [SA]. The median age was 64, and 70.6% were female. The incidence of PJI was 1.2% [5/420] in THA, 4.6% [11/241] in TKA and 0% [0/9] in SA. PJI was significantly more prevalent in TKA [p = 0.029]. All of the PJIs showed early infection, and the median time for the development of PJI was 23.5 days [range 7-120 days]. The median total length of the hospital stay was seven times higher in PJI patients than patients without PJI [49 vs. 7 days, p = 0.001, retrospectively]. All hospital costs were 2- to 24-fold higher in patients with PJI than in those without PJI [p = 0.001]. In conclusion, the incidence and economic burden of PJI was high. Implementing a national surveillance system and infection control protocols in hospitals is essential for the prevention of PJI and a cost-effective solution for the healthcare system in low-middle-income countries
RESUMO
To compare the outcomes of arthroscopic, radioactive and combined synovectomies in patients with chronic non-specific recurrent synovitis who did not respond to conservative therapy. Twenty-nine patients enrolled between 2007 and 2011 were divided into 3 groups: group 1 was treated with arthroscopy, group 2 received a radioactive drug and group 3 received a combined [radioactive and arthroscopic] Synovectomy. Treatment efficacy was evaluated by comparing pre- and post-operative Lysholm knee scores [LKS], night pain, resting pain, activity pain and effusions using visual analogue scales [VAS]. Patient satisfaction was assessed using the visual analogue patient satisfaction scale [VAPSS]. The mean age of the study participants was 41.5 +/- 5.2 years [range 14-76], and the mean follow-up period was 33.6 +/- 3.2 months [range 17-78]. Before treatment, the mean LKS was 41.4 +/- 3.4 in group 1,39.6 +/- 3.3 in group 2 and 37.1 +/- 4.6 in group 3. After treatment, the corresponding mean LKS were 77.7 +/- 2.1, 81.6 +/- 2.8 and 91.3 +/- 2.7 in groups 1, 2 and 3, respectively; the increase was statistically significant [p < 0.05]. The VAS scores before and after treatment decreased significantly [p < 0.05]. The mean VAPSS score, a measure of patient satisfaction, was 5.1 +/- 1.7, 5.8 +/- 1.5 and 7.4 +/- 1.8 in groups 1, 2 and 3, respectively, and the difference between groups 1 and 2 was not statistically significant, while that between group 3 and the other two groups was significant [p < 0.05]. This study showed that the three methods used in individuals with chronic non-specific recurrent synovitis were effective; however, arthroscopic Synovectomy in combination with radioactive Synovectomy was more effective than the other methods and superior in terms of patient satisfaction